5-Vendor Information.pdf

This is a Vendor Information form for the Louisville Metro Government's Medical Navigation Program, a 911 Medical Call Diversion Program managed by Louisville Metro Emergency Services in Kentucky. The proposal seeks qualified vendors to implement a program that diverts low-acuity medical calls from Emergency Medical Services to more appropriate care pathways. Callers meeting defined criteria will be triaged by medical professionals over the phone, with care pathways developed based on assessed needs. Services include in-home instructions, referrals to appropriate medical care facilities, primary care physician contact, telehealth options, and transportation arrangement to and from the determined care path. The form is dated 9/11/2025 and serves as the standardized document for vendor participation in this procurement opportunity.

The Vendor Information form requests standard business identification details including legal business name, address, contact information, Metro Louisville Revenue Commission Number, Federal ID Number, and Unique Entity Identifier. The form captures designated contacts for both contract administration and invoice processing, along with authorized agent signature and credentials. It includes sections for supplier classification and ownership status, allowing vendors to indicate minority, women, disabled, LGBT, and non-profit ownership designations, as well as applicable certifications such as MBE, WBE, DIBE, LGBTBE, VOSB, and SDVOSB status. Additionally, the form documents race and ethnicity information for compliance and reporting purposes. The document appears to be a standard template with multiple vendor entry capability, supporting the intake of multiple proposals for this Louisville Metro Government procurement.